依托综合医院康复医学科对偏瘫病人进行社区康复的模式探索
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摘要
目的:探索基于综合医院康复医学科对偏瘫病人进行社区康复治疗的诊疗模式。方法:选取崇州市各社区医疗机构接诊的偏瘫病人62例作为观察组,同期崇州市人民医院接诊的偏瘫病人48例作为对照组。对照组病人一直在医院康复中心进行系统性的康复治疗,观察组病人依托综合医院康复医学科对偏瘫病人进行社区康复。6个月后,采用简易Fugl-Meyer(FMA)量表、改良Barthel(BI)指数、汉密尔顿焦虑量表(HAMA)评价2组病人的治疗效果,并比较病人的康复治疗费用。结果:康复前,2组病人的FMA、BI、HAMA评分差异均无统计学意义(P>0.05)。康复6个月后,2组FMA、BI评分均明显高于康复前(P<0.01),HAMA评分均低于康复前(P<0.05);2组病人的FMA、BI评分差异均无统计学意义(P>0.05),观察组HAMA评分明显高于对照组(P<0.01)。观察组康复治疗平均总费用为(24 674.8±3 861.2)元,明显低于对照组的(38 672.5±6 167.4)元(P<0.01)。结论:社区医院在综合医院的参与指导下共同管理偏瘫病人,对其进行身躯康复治疗是既经济又有效的,并对康复医疗体系的建设有促进作用。
Objective:To explore the community rehabilitation mode for hemiplegic patients relied on rehabilitation medicine of general hospital.Methods:Sixty-two hemiplegic patients from Chongzhou City community medical institutions and 42 cases from Chongzhou People′s Hospital were divided into the observation group and control group,respectively.The control group was treated with systematic rehabilitation method in rehabilitation center of hospital,and the observation group was treated with the community rehabilitation mode relied on rehabilitation medicine of general hospital.After six months,the treatment effects in two groups were evaluated using the simple Fugl-Meyer(FMA) scale,improved Barthel index(BI),and Hamilton Anxiety Scale(HAMA),and the rehabilitation costs between two groups were compared.Results:There was no statistical significance in the scores of FMA,BI and HAMA between two groups before rehabilitation(P>0.05).After 6 months of rehabilitation,the scores of FMA and BI in two groups were significantly higher than those before treatment(P<0.01),and the HAMA score in two groups were significantly lower than that before treatment(P<0.05).The differences of the scores of FMA and BI between two groups were not statistically significant(P>0.05),and the score of HAMA in observation group was significantly higher than that in control group(P<0.01).The average total cost of rehabilitation treatment in observation group[(24 674.8±3 861.2)yuan] was significantly lower than that in control group[(38 672.5±6 167.4)yuan](P<0.01).Conclusions:Under the guidance and co-management of general hospital,the physical rehabilitation treatment of hemiplegic patients in community hospitals is economic and effective,which can promote the construction of tertiary rehabilitation medical system.
Objective:To explore the community rehabilitation mode for hemiplegic patients relied on rehabilitation medicine of general hospital.Methods:Sixty-two hemiplegic patients from Chongzhou City community medical institutions and 42 cases from Chongzhou People′s Hospital were divided into the observation group and control group,respectively.The control group was treated with systematic rehabilitation method in rehabilitation center of hospital,and the observation group was treated with the community rehabilitation mode relied on rehabilitation medicine of general hospital.After six months,the treatment effects in two groups were evaluated using the simple Fugl-Meyer(FMA) scale,improved Barthel index(BI),and Hamilton Anxiety Scale(HAMA),and the rehabilitation costs between two groups were compared.Results:There was no statistical significance in the scores of FMA,BI and HAMA between two groups before rehabilitation(P>0.05).After 6 months of rehabilitation,the scores of FMA and BI in two groups were significantly higher than those before treatment(P<0.01),and the HAMA score in two groups were significantly lower than that before treatment(P<0.05).The differences of the scores of FMA and BI between two groups were not statistically significant(P>0.05),and the score of HAMA in observation group was significantly higher than that in control group(P<0.01).The average total cost of rehabilitation treatment in observation group[(24 674.8±3 861.2)yuan] was significantly lower than that in control group[(38 672.5±6 167.4)yuan](P<0.01).Conclusions:Under the guidance and co-management of general hospital,the physical rehabilitation treatment of hemiplegic patients in community hospitals is economic and effective,which can promote the construction of tertiary rehabilitation medical system.
引文
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[11] 熊智,余建英,邓佳辉.积极性社区康复及干预对精神分裂症病人精神症状及家庭经济负担的影响[J].海南医学,2017,28(2):339.
[12] 童秋瑜,李一婧,马文,等.针刺治疗中风后焦虑障碍30例临床研究[J].江苏中医药,2017,49(4):62.
[13] 彭欣.逍遥散加减联合针灸治疗中风后焦虑症疗效观察[J].亚太传统医药,2017,13(12):120.
[2] 卓大宏,贝维斯,李建军,等.中国社区康复的现状、面临的挑战和发展趋势[J].中国康复医学杂志,2015,30(7):635.
[3] 潘宇,梁超,王亮,等.我院康复医疗服务体系建设的做法与体会[J].中国医院管理,2015,35(12):88.
[4] 中华神经病学会.脑血管病诊断要点[J].中华神经科杂志,1996,29(6):379.
[5] 杜小正,王金海,鲍春龄,等.头穴捻转补泻手法针刺对急性缺血性中风偏瘫病人肢体肌力的即刻影响:随机对照研究[J].中国针灸,2016,36(1):43.
[6] 张婉春,韩海英,孙冉.社区康复训练和持续健康教育对慢性恢复期精神分裂症病人自我效能感影响的研究[J].首都医科大学学报,2014,35(4):492.
[7] 焦丽琴,高淑凤,孙培云.综合性医院指导的社区综合康复治疗脑卒中偏瘫的临床研究[J].中西医结合心脑血管病杂志,2013,11(10):1218.
[8] 唐晓娜,曾瑶,陈阳阳,等.穴位贴敷结合艾灸辅助综合康复疗法治疗缺血性脑卒中偏瘫的临床观察[J].中医临床研究,2016,8(16):29.
[9] 孙培云,高淑凤,焦丽琴.综合型医院与社区联合康复治疗脑卒中病人的研究[J].中西医结合心脑血管病杂志,2013,11(3):323.
[10] 杨瑛,赵李克,曹英华.早期个性化心理护理在脑卒中病人治疗中的应用[J].中国临床医学,2016,23(3):405.
[11] 熊智,余建英,邓佳辉.积极性社区康复及干预对精神分裂症病人精神症状及家庭经济负担的影响[J].海南医学,2017,28(2):339.
[12] 童秋瑜,李一婧,马文,等.针刺治疗中风后焦虑障碍30例临床研究[J].江苏中医药,2017,49(4):62.
[13] 彭欣.逍遥散加减联合针灸治疗中风后焦虑症疗效观察[J].亚太传统医药,2017,13(12):120.
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